Main Street RX

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MAIN STREET RX

Doing business as

Main Street Pharmacy

Practice address

117 E Main St
East Prairie, MO 63845-1136

Phone

(573) 649-9229

NPI assigned

Feb 3, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Wood, PHARMD

Title

Member/Manager

Phone

(573) 335-8207

Specialties & licenses 1

Addresses

Other names 1

• Main Street Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MO3 enrollments

Enrollment records 3

Tax ID family

Main Street Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Main Street RX, LLC

  dba Main Street Pharmacy LTC

  • Long Term Care Pharmacy
  • East Prairie, MO
  • NPI 1164284634
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan Hubbard, PHARMD.

  • Pharmacist
  • East Prairie, MO
  • NPI 1285262519
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592265600000",
    "number": "1295366797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 DOCTORS PARK STE 2",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034903",
            "telephone_number": "573-334-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E MAIN ST",
            "city": "EAST PRAIRIE",
            "state": "MO",
            "postal_code": "638451136",
            "telephone_number": "573-649-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET RX",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-03",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "573-335-8207",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Main Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jimmy D. Heath Jr., M.D.
• Patricia Hogan, RPH
• Bryan Hubbard, PHARMD.
• Main Street Pharmacy LLC (Main Street Pharmacy)
• Main Street Pharmacy LLC.
• Main Street RX, LLC (Main Street Pharmacy LTC)
• Susan Myrick Marshall, PHARMD
• Teresa Leann Morris, LCSW
• N & R of East Prairie, Inc. (East Prairie Nursing Center)
• Jennifer Samantha Presson

• Community/Retail Pharmacy in East Prairie, MO
• Providers in East Prairie, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.